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One in five patients hospitalized for heart attack suffers from major depression, and these patients may be more likely than other heart attack patients to need hospital care again within a year for a cardiac problem and three times as likely to die from a future attack or other heart problems, according to a new evidence report by HHS' Agency for Healthcare Research and Quality.

The scientific evidence review on which the report is based suggests that 60 percent to 70 percent of individuals who become depressed when hospitalized for heart attack continue to suffer from depression for 1 month to 4 months or more after discharge. Major depression lasts 2 weeks or longer and is accompanied by five or more symptoms—including feelings of sadness, hopelessness, pessimism and a general loss of interest in life—that hinder a person's ability to carry out normal, everyday activities.

The reviewers also found that, during the first year following a heart attack, those with major depression can have a delay in returning to work, worse quality of life, and worse physical and psychological health. In fact, some studies show that depression that begins while the patient is hospitalized can continue to affect his or her psychological and physical health for as long as 5 years after discharge. Approximately 765,000 Americans were discharged following treatment for heart attacks in 2002, according to national hospital data from AHRQ.

"This report provides the scientific evidence clinicians need to know about the prevalence of depression in heart attack survivors, how depression affects these patients, and the need to treat the disease early," said AHRQ Director Carolyn M. Clancy, M.D.

The American Academy of Family Physicians, which requested the evidence review, plans to use the report to develop evidence-based clinical practice guidelines.

The reviewers found strong evidence that both counseling and certain antidepressants, such as selective serotonin reuptake inhibitors, are effective at reducing symptoms of depression in patients following a heart attack, but there is no evidence that either therapy reduces the likelihood of suffering future cardiac events or the odds of dying from them.

Reviewers of the AHRQ-supported Johns Hopkins University Evidence-Based Practice Center in Baltimore, led by David E. Bush, M.D., and Roy C. Ziegelstein, M.D., could not conclude whether the frequency of needing prescription medicines for cardiac problems or cardiac procedures is influenced by depression. However, they did find relatively strong evidence that patients with post-heart attack depression are less likely than other heart attack survivors to take their medications as instructed or to follow doctors' advice for helping to prevent future heart attacks by losing weight, reducing salt consumption or exercising, for example.

The reviewers found insufficient evidence to adequately assess the performance of methods used to screen patients for depression while patients are hospitalized for heart attack. However, the review also found that most of the commonly used screening instruments and rating scales are accurate enough to identify depression when used within 3 months after the patient's initial hospitalization for heart attack.

The reviewers called for additional research to expand the evidence base, including studies to determine the major causes of death among depressed post-heart attack patients, whether treatment improves their outcomes relative to similar patients not suffering from depression and the definition of the most clinically relevant measure of depression during initial heart attack hospitalization.

Details are in Evidence Report on Post-Myocardial Infarction Depression. The summary and the full report are available on AHRQ's Web site at http://www.ahrq.gov/clinic/tp/mideptp.htm. Printed copies are available by calling AHRQ's Publications Clearinghouse at (800) 358-9295 or sending an E-mail to AHRQPubs@ahrq.hhs.gov.

AHRQ conducts and sponsors a wide range of studies designed to find the best scientific evidence for what works and what doesn't. This research was conducted by one of AHRQ's 13 Evidence-based Practice Centers, which review all relevant scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and technology assessments. These reports are used for informing and developing coverage decisions, quality measures, educational materials and tools, guidelines and research agendas.

For more information, please contact AHRQ Public Affairs: (301) 427-1539 or (301) 427-1865.

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